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Plastic and Reconstructive Surgery.... Aug 2019Dual-plane augmentation mammaplasty has gained wide popularity in treating breast ptosis. However, in our experience, dual-plane augmentation mastopexy fails to treat...
UNLABELLED
Dual-plane augmentation mammaplasty has gained wide popularity in treating breast ptosis. However, in our experience, dual-plane augmentation mastopexy fails to treat severe cases of ptosis (grade 3) and glandular ptosis. Therefore, we conceived a method to manage these cases effectively. The aim was to achieve harmonious, natural fullness, better projection, and appropriate size with limited scarring. We named this technique triple-plane augmentation mastopexy as three planes are used: the first plane is the subfascial plane, the second is the subglandular plane, and the third is the subpectoral plane.
METHODS
A retrospective review was performed of 75 consecutive cases of grade 3 or glandular ptosis treated in a single clinic by three separate surgeons adopting the same technique from January 2010 to January 2017. Triple-plane augmentation mastopexy begins by undermining the breast tissue through a tunnel until the second rib is in the prepectoral plane. Then, the subpectoral pocket for the implant is dissected with release of the lower border of the pectoralis major and avoiding release of the sternal border. Subsequently, the breast tissue is suspended at the lower border of the second rib, followed by subpectoral insertion of the implant and skin envelope excision.
RESULTS
Surgical follow-up varied from a minimum of 6 months to a maximum of 6 years, with an average of 3 years. Among a total of 75 patients, 64 patients (85.3%) complied with follow-up and 49 (76.5%) of these patients were satisfied. Complications varied from early complications (14.6%) to late complications (21.5%).
CONCLUSIONS
Grade 3 and glandular ptosis represent a challenge to plastic surgeons. Traditional techniques may fail to achieve optimized results. Triple-plane augmentation mastopexy is a safe, reliable procedure that ensures long-term desired aesthetic outcomes with limited scarring.
PubMed: 31592039
DOI: 10.1097/GOX.0000000000002344 -
Plastic and Reconstructive Surgery.... Sep 2023Breasts are considered one of the most physically and sexually appealing features of the female body. Reduction/augmentation techniques have greatly evolved in the last...
BACKGROUND
Breasts are considered one of the most physically and sexually appealing features of the female body. Reduction/augmentation techniques have greatly evolved in the last decades.We are reporting our experience with an innovative technique for mastopexy that recovers the aesthetics of the breast and avoids over-resection of its lower pole.
METHODS
Inclusion criteria were women who underwent kite mastopexy with or without implants between January 2018 and May 2022 in a single center (Bogota, Colombia). Exclusion criteria were patients with American Society of Anesthesiology score more than II, with any uncontrolled chronic illness and/or medical history of diabetic mellitus, metabolic syndrome, body mass index more than 32 kg per m, and active smokers.
RESULTS
We found 133 consecutive female patients. Age range was 18 and 67 years (median 39). Breast implants were used for the purpose of kite mastopexy in 52% cases. Patients were divided into two groups: implants (group 1) versus no implants (group 2). Procedure 1 involved mastopexy without implants; procedure 2 included current implant users who underwent either implant removal or in whom implants were not used for the sake of mastopexy. Procedures 3 and 4 included patients who underwent either new implant placement or implant exchange, respectively. Average time of surgery was 1.5 hours. Minor complications were mostly related to wound dehiscence. No major complications were reported.
CONCLUSIONS
Kite mastopexy restores the breast aesthetics by following specific markings, a new plication of breast pillars, and a reduced scar. Our technique demonstrates a very low rate of complications while entailing natural and appealing results.
PubMed: 37718994
DOI: 10.1097/GOX.0000000000005265 -
Gland Surgery Jan 2021Immediate oncoplastic breast reconstruction performed at the time of breast conserving surgery for the treatment of breast cancer merges the therapeutic goals of... (Review)
Review
Immediate oncoplastic breast reconstruction performed at the time of breast conserving surgery for the treatment of breast cancer merges the therapeutic goals of complete oncologic extirpation with preservation of breast form and function. A constellation of surgical techniques that employs breast volume displacement and/or replacement methods of varying complexity levels have emerged, thus broadening the potential applications for breast conservation therapy to include cases with increased tumor-to-native breast-volume ratios, multicentric or multifocal disease, and/or previous margin-positive resections. This review describes the various reconstructive methods, including the use of local tissue rearrangement, oncoplastic reduction-mastopexy, and locoregional flaps. Classification of the surgical options into levels I and II volume-displacement and volume-replacing techniques is made. Additionally, we explore the oncologic safety and effectiveness of this treatment paradigm by summarizing existing supportive evidence regarding associated risk of surgical complications, rate of margin-positive resection, implications for radiographic surveillance, local recurrence rates, and patient-reported outcomes. In conclusion, surgeons may use a wide variety of oncoplastic techniques for partial breast reconstruction at the time of segmental mastectomy to deliver effective breast conserving treatment for women with breast cancer. A growing body of literature affirms the oncologic safety of this approach. Future directions for research include long-term follow-up data with emphasis on outcomes from patient perspectives.
PubMed: 33633998
DOI: 10.21037/gs-20-380 -
Plastic and Reconstructive Surgery.... Oct 2020Autologous mastopexy is an alternative for patients with small breasts, ptosis and upper pole hollowness, who desire improvement in their breast shape without using an...
BACKGROUND
Autologous mastopexy is an alternative for patients with small breasts, ptosis and upper pole hollowness, who desire improvement in their breast shape without using an implant. A variety of techniques have been tried throughout the years. Recently the use of autologous fat grafting (AFG) for breast augmentation increased in popularity and showed satisfying cosmetic outcome in enhancement of size, shape and texture of the breast.
METHODS
25 patients with grade 2 ptosis were included in this study. Lower Island Flap Transposition (LIFT) technique was modified and either done alone or in combination with lipofilling, whether at the same setting or as a second stage. Preoperative and postoperative measurements and pictures were documented.
RESULTS
Lateral upper pole projection measurements showed an average increase of 28.5% equal to about 1.8 cm. As for the maximum breast projection an increase of about 33% accounting for about 2 cm was documented.
CONCLUSIONS
This study shows that the combination of LIFT technique after its modification with AFG has proven to be an effective technique with consistent results for patients presenting with grade 2 ptosis and upper pole hollowness. The addition of AFG to the modified LIFT technique can be considered a step forward in achieving autoaugmentation and autologous mastopexy without using implants.
PubMed: 33173668
DOI: 10.1097/GOX.0000000000003126 -
Plastic and Reconstructive Surgery.... Oct 2020Breast ptosis is a common occurrence following weight loss, pregnancy, and breastfeeding, or as a consequence of normal aging. This results in loss of a youthful shape... (Review)
Review
Breast ptosis is a common occurrence following weight loss, pregnancy, and breastfeeding, or as a consequence of normal aging. This results in loss of a youthful shape and contour of the breast, with a change in the position of the nipple-areolar complex. Mastopexy can restore this youthful appearance and transpose the nipple-areolar complex to a more aesthetic position on the breast. Various techniques exist that address the skin and parenchyma of the breast and are chosen based on the degree of ptosis and skin laxity, as well as the patient's goals. These techniques all differ in scar burden and risk profile. Additionally, this can be done simultaneously or in a staged manner. In this literature review, we aim to provide an overview of mastopexy procedures, with and without augmentation. Further, we aim to detail recent advancements in technical approaches, and delineate common complications in certain patient demographics. To this end, we performed a literature search with a medical librarian, using PubMed/Medline to identify pertinent literature. In the context of the review, we discuss important considerations in patient selection and counseling to set expectations and ultimately, optimize surgical outcome and patient satisfaction.
PubMed: 33173660
DOI: 10.1097/GOX.0000000000003057 -
Gland Surgery Sep 2021This review article summarises the latest evidence for commonly undertaken procedures in aesthetic breast surgery with a focus on key principles of breast augmentation,... (Review)
Review
OBJECTIVE
This review article summarises the latest evidence for commonly undertaken procedures in aesthetic breast surgery with a focus on key principles of breast augmentation, reduction, and mastopexy. The paper also outlines various approaches and controversies as well as complications such as breast implant associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant illness (BII) which are increasingly being recognised and becoming a challenge to manage.
BACKGROUND
Changing trends of aesthetic breast surgery over the decades has warranted a continuous evolution of this field. The ability to deliver safe and appropriate care is dependent upon sound reconstructive principles and proper training. The lack of uniformity in either is a cause of concern. The impact of social media and changing perception of body image can also no longer be overlooked in the field of aesthetics and reconstruction.
METHODS
Review of literature including recent journals, textbook chapters, online databases like PubMed, and current government and surgical society guidelines.
CONCLUSIONS
Breast reconstruction is based on sound surgical principles and it is imperative to follow these for the practice of this speciality. There are two important issues that revolve around this aspect of surgery. First relates to the urgent need to invest time and effort in improving regulations and outcomes in the cosmetic surgery industry. Second, it is crucial to promote and prioritize the development and training in this field as the principles of aesthetic breast surgery underpins oncoplastic breast surgery for management of cancer.
PubMed: 34733731
DOI: 10.21037/gs-20-892 -
Journal of Nippon Medical School =... Jun 2021Various skin incision methods have been reported for reduction mammoplasty and mastopexy. This report describes a new incision method that may improve on conventional...
OBJECTIVE
Various skin incision methods have been reported for reduction mammoplasty and mastopexy. This report describes a new incision method that may improve on conventional methods, particularly with respect to prevention of hypertrophic scars.
METHODS
We developed a comma-shaped incision method that results in fewer scars and less strain on the suture line. We then applied this new method to two cases, namely, one case of breast reduction and one case of breast fixation.
RESULTS
In both cases, we achieved good results. There was no scar at the inframammary fold, and no hypertrophic scar formation. All scars were within the breast area and were not in contact with the brassiere wire; hence, there was less pain after the operation.
CONCLUSIONS
We developed a new incision method for reduction mammoplasty and mastopexy.
Topics: Adult; Cicatrix, Hypertrophic; Dermatologic Surgical Procedures; Female; Humans; Mammaplasty; Mammary Glands, Human; Mammography; Middle Aged; Nipples; Surgical Wound
PubMed: 32863344
DOI: 10.1272/jnms.JNMS.2021_88-313 -
JPRAS Open Dec 2022Mastopexy and reduction mammaplasty are commonly performed procedures in plastic surgery with many variations in incision pattern, pedicle design, and additional support... (Review)
Review
BACKGROUND
Mastopexy and reduction mammaplasty are commonly performed procedures in plastic surgery with many variations in incision pattern, pedicle design, and additional support maneuvers. Aesthetically pleasing on table results are widely accomplished; however, the longevity of the outcome and sustained correction of ptosis or pseudoptosis is not universal. A systematic review of mastopexy and reduction mammaplasty procedures was performed to investigate which techniques provided the greatest long-term correction of ptosis.
METHODS
A broad search of the literature was performed using the PubMed database from inception to December of 2021. Study characteristics, number of patients, number of breasts, technique, outcome, and average follow-up time were extracted for analysis. Study quality was assessed using the Newcastle-Ottawa Scale when applicable.
RESULTS
The primary search yielded 1123 articles. After two levels of screening, 24 articles were identified for analysis. This included 16 case series, seven cohort studies, and one randomized controlled study. From these studies, 1235 patients and 2235 breasts were analyzed. The majority of articles reported on a change in the nipple to inframammary fold and sternal notch to nipple distances.
CONCLUSIONS
In the analytical studies, superior and superomedial pedicles tended to provide greater long-term stability than inferior pedicles. Mesh, dermal suspension flaps, and muscular slings showed promise in providing additional support over standard techniques. No single procedure is ideal for all patients; however, this systematic review provides a valuable description of techniques and long-term outcomes to guide surgical planning.
PubMed: 36061406
DOI: 10.1016/j.jpra.2022.05.003 -
Plastic and Reconstructive Surgery.... May 2022
PubMed: 35620499
DOI: 10.1097/GOX.0000000000004343